Anemia - Introduction
Normal Erythropoiesis
Kidney
Oxygen
sensor
Epo
mRNA
Epo
Blood vessel
Bone marrow Multi-potent
stem cell
Erythroid
stem cell
3-4
days
Peripheral
blood
RBC survival
100-120 days
Anemia
• Understanding anemia– Disease - to be treated on its own merits– Condition - a secondary manifestation of
another disease– Symptoms depend on severity/acuity
• Causes– Decreased production– Blood loss– Hemolysis
Laboratory Evaluation of Anemia
• Complete blood count• Peripheral smear• Reticulocyte count
– Relative reticulocyte count♦ Percent of all RBC (normal 0.8%–1.5%)
– Absolute reticulocyte count♦ Relative reticulocyte count x RBC count♦ Normal 50,000–75,000/µl♦ Examples:
1.1% x 4.96 x106 = 55,000/l
12.2% x 2.05 x106 = 250,000/l
MCV
Microcytic Normocytic Macrocytic
Low Common Common Common
High Uncommon Common Uncommon
Retic
count
Classification of Anemia Based on RBC Kinetics and Size
Microcytic Hypochromic Anemia: Diagnosis
• Mild (MCV > 70 fl)– Iron deficiency – Thalassemia– Lead toxicity– Sideroblastic anemia– Anemia of chronic
disease
• Severe (MCV < 70 )– Iron deficiency– Thalassemia
Macrocytic Anemia with Low Reticulocyte Count
• Megaloblastic anemia– Vitamin B12 deficiency– Folate deficiency
• Non-megaloblastic macrocytic anemia– Liver disease– Hypothyroidism– Drug-induced (DNA synthesis block)– Myelodysplastic syndrome
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